EmailMe Form - RPAW Dog Adoption Application

Name *

First Last

Address *

Street Address City State / Province / Region Postal / Zip Code

Email *

Phone *

### - ### - ####

Alternate Phone

### - ### - ####

Birth Date *

MM / DD / YYYY

Drivers License #

ABOUT YOUR DECISION

Name of dog you are interested in adopting *

Why are you interested in this specific dog? *

What is the primary reason you are getting a dog at this time? *

How long have you been looking to add a dog to your family? *

Have you looked at other shelters or rescue groups? *

Yes

No

ABOUT YOUR FAMILY

How many people are in your household? *

Adult 1 works *

Part time

Full time

Not applicable

Adult 2 works *

Part time

Full time

Not applicable

Are there children in your home? *

Yes

No

If yes, what are their ages?

Please list any other animals in the home.

Include species, breed, name, age, sex, altered (yes or no)

Do any family members have allergies to animals? *

Yes

No

If yes, please specify allergies:

ABOUT YOUR ENVIRONMENT

Do you have a fenced yard? *

Yes

No

If no, how will the dog be contained when outside?

If yes, what type of fencing and how high?

chain link, privacy, invisible, etc.

ABOUT YOUR LIVING SITUATION

Do you own or rent? *

Own

Rent

Written approval from landlord required if renting

Type of dwelling *

Do you belong to a neighborhood or mobile home association? *

Yes

No

If renting, landlord's name

If renting, landlord's phone number

### - ### - ####

If your living situation should change, such as moving or a change in family status, would you feel the need to return the dog? *

Yes

No

ABOUT YOUR DAY

Briefly describe a typical day for you and your family *

How is the new dog going to be a part of your family? How long will the new dog be unattended? Are you typically home during the evening or busy on the weekends?

Where will the dog be kept when you aren't home? *

Where will the dog be allowed in the home? *

Where will the dog sleep at night? *

FAMILY DOG HISTORY

Have you owned a dog before? *

Yes

No

Dog's name(s), breed, dates of ownership

Please also include what happened to the dog (surrendered, deceased, ran away, still have)

Have you ever surrendered a pet? *

Yes

No

Have you ever lost a pet that you didn't recover? *

Yes

No

If you answered yes to either of the last two questions, please explain what happened.

OBEDIENCE KNOWLEDGE

Have you ever taken a dog to an obedience class? *

Yes

No

When, where, why?

Explain any training skills you have

Do you think it's a good idea for dogs to attend a basic obedience class? *

Yes

No

Will you be taking your new dog to an obedience class? *

Yes

No

BEHAVIOR CONSIDERATIONS & BASIC CARE

For what reasons might you return this dog *

Who will be the primary caretaker for the dog? *

feeding, grooming, training, etc.

Do you know how to check a dog's collar for proper tightness? *

Yes

No

Do you know how to maintain a proper weight for your new dog? *

Yes

No

Do you know what steps to take if your dog goes missing? *

Yes

No

What type of exercise will you participate in with your dog? *

Name and address of current vet (if applicable)

Are you willing to assume ALL veterinary costs for this dog from the date of adoption? *

Yes

No

Would you like to be placed on an RPAW email list to be updated about future events?

Yes

No

Rescued Pets Are Wonderful reserves the right to determine whether or not its in the best interest of the animal to be adopted by any individual, and it not, to refuse the adoption.